PURE LAPAROSCOPIC DONOR NEPHRECTOMY: DOES THE SIDE OF EXTRACTON AFFECT OUTCOMES?

eric K diner, bart radolinski, jonah murdock, S R ghasemian
washington hospital center, washington, DC

Purpose: We reviewed our recent series of 142 pure laparoscopic living donor nephrectomies performed by one surgeon at Washington Hospital Center to determine if the side of extraction affects various operative parameters and outcomes, and post-operative complications.
Materials and Methods: Between January 2003 and January 2005, 142 (97 left and 45 right) consecutive patients underwent pure laparoscopic living donor nephrectomy. The left and right sided procedures were compared in the following categories: surgical time, warm ischemia time, post-operative analgesia and length of stay, and any complications that occurred.
Results: The mean operative time of a right donor nephrectomy was 195 minutes versus 210 minutes on the left side. The mean warm ischemia time was less than 5 minutes regardless of side. An analgesia and length of stay protocol was initiated whereby patients were discharged on post-operative day 2 or 3 with any length of stay beyond 3 days considered a complication. 14 patients (6 left, 8 right) fell in this category. 12 patients had a post-operative ileus (5 left, 7 right), one patient (left) had a re-operation for an unrecognized bowel injury, one patient required a blood transfusion, and 5 patients (2 left, 3 right) had prolonged pain.
Conclusions: Classically, pure laparoscopic donor nephrectomy was performed solely on the left due to increased length of the left renal vein. We challenge this notion and propose to remove the kidney that is smaller, without nephrolithiasis, and with only single renal vessels and show that operative parameters and post-operative results are equal.

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